Novel Decision Support Interventions for Low-risk Thyroid Cancer
Novel Decision Support Interventions for Low-risk Thyroid Cancer
The treatment paradigm for low-risk thyroid cancer increased in complexity following release of the 2015 American Thyroid Association Guidelines for Adults with Differentiated Thyroid Cancer. Although the intention of the guidelines were to “complement informed, shared patient-healthcare provider deliberation” when making treatment decisions, patient-clinician deliberation can fail to meet patients’ needs and may exclude available treatment.
In this research letter, Dr. Susan Pitt and Megan Saucke examined a patient-oriented intervention to support decision-making about low-risk thyroid cancer treatment. The duo held 16 stakeholder meetings between July 2016 and December 2017 to develop a 1-page treatment comparison chart and a trifold pamphlet containing a question prompt list (available at https://www.hipxchange.org/ThyroidCancerTreatmentChoice).
Chemoprevention of Colorectal Cancer
Chemoprevention of Colorectal Cancer
Although colorectal cancer (CRC) screening has reduced the incidence of and mortality from CRC, chemoprevention strategies have the potential to further reduce CRC incidence and mortality. Chemoprevention agents might be used for average-risk as well as high-risk groups, and to prevent CRC recurrence after therapy. CRC chemoprevention agents that have been studied include aspirin, nonaspirin nonsteroidal anti-inflammatory drugs, statins, agents that target metabolic pathways, and vitamins and minerals.
In this article, HIP Investigator Dr. Jennifer Weiss along with Dr. Bryson Katona reviewed the prospect of chemoprevention of colorectal cancer, results from preclinical and human studies, challenges, and future directions.
Variation in Hospitalization Rates Following Emergency Department Visits in Children with Medical Complexity
Variation in Hospitalization Rates Following Emergency Department Visits in Children with Medical Complexity
Children with medical complexity (CMC) have lifelong, complex chronic conditions (CCCs) associated with multimorbidity, severe functional limitations, myriad health care needs, and high resource use. Although hospitalizations have been a long-standing measure of a potentially avoidable CMC health service, little is known about the opportunity to influence the hospitalization risk from an ED visit. Therefore, HIP Investigator Dr. Ryan Coller et al. identified factors associated with admission within ED encounters and quantified both the overall ED admission rate for CMC and admission rate variation across children's hospitals.
A robust approach to sample size calculation in cancer immunotherapy trials with delayed treatment effect
A robust approach to sample size calculation in cancer immunotherapy trials with delayed treatment effect
A group of authors including HIP Investigator, Dr. Menggang Yu et al. presents an approach to calculate sample size based on a maximin efficiency robust test. Both theoretical derivations and simulation results show the proposed approach can guarantee the desired power in worst case scenarios and often much more efficient than existing approaches. Application to a real trial design is also illustrated.
Optimal treatment assignment to maximize expected outcome with multiple treatments.
Optimal treatment assignment to maximize expected outcome with multiple treatments.
When there is substantial heterogeneity of treatment effectiveness, it is crucial to identify individualized treatment assignment rules for comparative treatment selection. HIP Investigator, Dr. Menggang Yu et al. propose an outcome weighted learning method that extends estimating individualized treatment rules to multi‐treatment case by using a vector hinge loss as a target function. Consistency of the resulting estimator is shown in the article.
Primary care colorectal cancer screening correlates with breast cancer screening
Primary care colorectal cancer screening correlates with breast cancer screening
In a retrospective cohort study, Dr. Jennifer Weiss et al. examined 90 primary care providers (PCPs) and over 33,000 patients eligible for colorectal cancer (CRC) screening to determine whether PCP colorectal cancer screening practices correlate with other preventive and chronic care needs. The investigators looked at CRC screening rates in comparison to five other PCP quality metrics—breast cancer screening, cervical cancer screening, HgbA1c and LDL testing, and blood pressure control—and found that PCP CRC screening rates have a strong correlation with breast cancer screening rates and a weak correlation with the other metrics. These results indicate that efforts to increase PCPs' CRC screening rates could be bundled with breast cancer screening improvement interventions to increase their impact.
Insurance Coverage for CT Colonography Screening: Impact on Overall Colorectal Cancer Screening Rates.
Insurance Coverage for CT Colonography Screening: Impact on Overall Colorectal Cancer Screening Rates.
Dr. Maureen Smith et al. compared colorectal cancer (CRC) screening rates for patients with and without insurance coverage for CT colonography. Using longitudinal electronic health record data, the investigators found that among patients who became due for CRC screening, there was a 48% greater likelihood of them getting screened by any method if they had insurance coverage for CT colonography when compared to those who did not have insurance coverage.
Utilization of preoperative endoscopic ultrasound for pancreatic adenocarcinoma
Utilization of preoperative endoscopic ultrasound for pancreatic adenocarcinoma
In this study, Dr. Ryan Schmocker et al. examined patterns of preoperative endoscopic ultrasound (EUS) for pancreatic adenocarcinoma and the impact on downstream treatment. The investigators used the SEER-Medicare database to conduct the study and found the factors most associated with receipt of EUS were: earlier year of diagnosis, SEER area, and an NCI or academic hospital. EUS was associated with a longer time to surgery and higher number of staging tests.
PCP adoption of CT colonography for colorectal cancer screening
PCP adoption of CT colonography for colorectal cancer screening
In a recent study by Dr. Jennifer Weiss et al. to examine factors influencing primary care provider adoption of CT colonography (CTC) for colorectal cancer screening, the authors linked survey responses with electronic health record data and found that substantial variation in the use of CTC for screening existed among primary care providers and clinics.
Primary care providers were more likely to recommend CTC for screening if they specialized in Internal Medicine, perceived that it was effective in reducing mortality from colorectal cancer, or thought that CTC had a higher number of perceived advantages.
Variation in the types of providers participating in breast cancer follow-up care
Variation in the types of providers participating in breast cancer follow-up care
Dr. Heather Neuman et al. aimed to describe the types of providers participating in early follow-up care of older breast cancer survivors. Using the SEER-Medicare database, investigators found 80% of follow-up care was with a medical oncologist, 46% with a surgeon, and 39% with a radiation oncologist after radiation treatment. Patients with larger tumor size, positive axillary nodes, estrogen receptor-positive status, and chemotherapy treatment were more llikely to have medical oncology follow-up.